Provider First Line Business Practice Location Address:
GRAND LAKE PRIMARY CARE AT ST MARYS
Provider Second Line Business Practice Location Address:
1140 S KNOXVILLE AVE STE A
Provider Business Practice Location Address City Name:
SAINT MARYS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45885-2609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-394-9959
Provider Business Practice Location Address Fax Number:
419-394-0255
Provider Enumeration Date:
09/14/2006